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Rhys-Evans S, Howard SR. Combined gonadotropin therapy to replace mini-puberty in male infants with congenital hypogonadotropic hypogonadism. Ann N Y Acad Sci 2024; 1537:32-40. [PMID: 38924109 DOI: 10.1111/nyas.15177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2024]
Abstract
Infants born with severe central disorders of the hypothalamic-pituitary-gonadal axis leading to gonadotropin deficiency not only lack pubertal development in adolescence, but also lack infantile mini-puberty. This period of mini-puberty, where infants have gonadotropin and sex steroid concentrations up into the adult range, is vital for future reproductive capacity, particularly in boys. At present, there is no consensus on the diagnosis or management of infants with gonadotropin deficiency due to congenital hypogonadotropic hypogonadism or multiple pituitary hormone deficiency. Case series suggest that gonadotropin treatment in male infants with absent mini-puberty is effective in promoting both testicular descent in those with undescended testes and also facilitating increased penile size. Moreover, replacement with follicle-stimulating hormone increases the testicular Sertoli cell population, measurable as an increase in testicular volume and inhibin B, thus hypothetically increasing the capacity for spermatogenesis in adult life for these patients. However, long-term follow-up data is limited for both outcomes pertaining to fertility and nonreproductive sequelae, including neurodevelopment and psychological well-being. The use of international registries for patients with gonadotropin deficiency is a key element in the collection of high-quality, geographically widespread data to inform best-practice management from birth to adulthood.
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Affiliation(s)
- Sophie Rhys-Evans
- Centre for Endocrinology, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Sasha R Howard
- Centre for Endocrinology, William Harvey Research Institute, Queen Mary University of London, London, UK
- Department of Paediatric Endocrinology, Barts Health NHS Trust, London, UK
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Giagulli VA, Guastamacchia E, Magrone T, Jirillo E, Lisco G, De Pergola G, Triggiani V. Worse progression of COVID-19 in men: Is testosterone a key factor? Andrology 2021; 9:53-64. [PMID: 32524732 PMCID: PMC7307026 DOI: 10.1111/andr.12836] [Citation(s) in RCA: 96] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 05/22/2020] [Accepted: 06/03/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND The novel severe acute respiratory syndrome coronavirus (SARS-CoV-2) disease 2019 (COVID-19) seems to have a worse clinical course among infected men compared with women, thus highlighting concerns about gender predisposition to serious prognosis. Therefore, androgens, particularly testosterone (T), could be suspected as playing a critical role in driving this excess of risk. However, gonadal function in critically ill men is actually unknown, mainly because serum T concentration is not routinely measured in clinical practice, even more in this clinical context. OBJECTIVE To overview on possible mechanisms by which serum T levels could affect the progression of COVID-19 in men. METHODS Authors searched PubMed/MEDLINE, Web of Science, EMBASE, Cochrane Library, Google, and institutional websites for medical subject headings terms and free text words referred to "SARS-CoV-2," "COVID-19," "testosterone," "male hypogonadism," "gender" "immune system," "obesity," "thrombosis" until May 19th 2020. RESULTS T, co-regulating the expression of angiotensin-converting enzyme 2 and transmembrane protease serine 2 in host cells, may facilitate SARS-CoV-2 internalization. Instead, low serum T levels may predispose to endothelial dysfunction, thrombosis and defective immune response, leading to both impaired viral clearance and systemic inflammation. Obesity, one of the leading causes of severe prognosis in infected patients, is strictly associated with functional hypogonadism, and may consistently strengthen the aforementioned alterations, ultimately predisposing to serious respiratory and systemic consequences. DISCUSSION AND CONCLUSION T in comparison to estrogen may predispose men to a widespread COVID-19 infection. Low serum levels of T, which should be supposed to characterize the hormonal milieu in seriously ill individuals, may predispose men, especially elderly men, to poor prognosis or death. Further studies are needed to confirm these pathophysiological assumptions and to promptly identify adequate therapeutic strategies.
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Affiliation(s)
- Vito A. Giagulli
- Interdisciplinary Department of Medicine ‐ Section of Internal Medicine, Geriatrics, Endocrinology and Rare DiseasesSchool of MedicineUniversity of Bari “Aldo Moro”BariItaly
- Outpatients Clinic of Endocrinology and Metabolic DiseaseConversano HospitalBariItaly
| | - Edoardo Guastamacchia
- Interdisciplinary Department of Medicine ‐ Section of Internal Medicine, Geriatrics, Endocrinology and Rare DiseasesSchool of MedicineUniversity of Bari “Aldo Moro”BariItaly
| | - Thea Magrone
- Department of Basic Medical Sciences, Neuroscience and Sensory OrgansUniversity of BariBariItaly
| | - Emilio Jirillo
- Department of Basic Medical Sciences, Neuroscience and Sensory OrgansUniversity of BariBariItaly
| | - Giuseppe Lisco
- Unit of Endocrinology, Metabolic Disease & Clinical NutritionHospital “A. Perrino"BrindisiItaly
| | - Giovanni De Pergola
- Departmentof Biomedical Sciences and Human OncologySection of Internal Medicine and Clinical OncologyUniversity of Bari Aldo MoroBariItaly
| | - Vincenzo Triggiani
- Interdisciplinary Department of Medicine ‐ Section of Internal Medicine, Geriatrics, Endocrinology and Rare DiseasesSchool of MedicineUniversity of Bari “Aldo Moro”BariItaly
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Canguven O. Commentary. Aging Male 2020; 23:310-311. [PMID: 30322322 DOI: 10.1080/13685538.2018.1515905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- Onder Canguven
- Hamad General Hospital, Department of Urology, Doha, Qatar
- Weill Cornell Medicine, Department of Urology, New York, NY, USA
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Kalra S, Bhattacharya S, Kalhan A. Testosterone in COVID-19 - Foe, Friend or Fatal Victim? EUROPEAN ENDOCRINOLOGY 2020; 16:88-91. [PMID: 33117437 PMCID: PMC7572157 DOI: 10.17925/ee.2020.16.2.88] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 07/21/2020] [Indexed: 01/08/2023]
Abstract
The evidence derived from observational studies suggests male gender, diabetes and central obesity to be risk factors associated with an increased COVID-19-related case fatality. The precise pathophysiology behind this gender difference in mortality outcomes remains unclear at this stage, although it is worth exploring a possible role of testosterone as one of the contributory factors. The observed role of androgens in transcription of transmembrane protease serine-2, which facilitates COVID-19 anchoring to angiotensin-converting enzyme 2 cell surface receptors, seems to suggest that higher testosterone levels might be detrimental for outcomes. On the other hand, men with type 2 diabetes mellitus and central obesity have an increased prevalence of hypogonadotropic hypogonadism, with inhibition of gonadotropin-releasing hormone secretion induced by inflammatory cytokines being one of the postulated mechanisms. The increased COVID-19 case fatality in this cohort might perhaps reflect an underlying pro-inflammatory state, with low testosterone levels being either a surrogate marker of a poor metabolic state or playing a more active role in propagation of inflammation and thrombosis.
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Affiliation(s)
- Sanjay Kalra
- Department of Endocrinology, Bharti Hospital, Karnal, India
| | | | - Atul Kalhan
- Department of Endocrinology, Royal Glamorgan Hospital, Cardiff, UK
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Kelada M, Anto A, Dave K, Saleh SN. The Role of Sex in the Risk of Mortality From COVID-19 Amongst Adult Patients: A Systematic Review. Cureus 2020; 12:e10114. [PMID: 33005531 PMCID: PMC7523740 DOI: 10.7759/cureus.10114] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 08/29/2020] [Indexed: 01/08/2023] Open
Abstract
A worldwide outbreak of coronavirus disease 2019 (COVID-19), identified as being caused by the severe acute respiratory syndrome coronavirus 2 (SARS-COV-2), was classified as a Public Health Emergency of International Concern by the World Health Organisation (WHO) on January 30, 2020. Initial sex-disaggregated mortality data emerging from the Wuhan province of China identified male sex as a risk factor for increased COVID-19 mortality. In this systematic review, we aimed to assess the role of sex in the risk of mortality from COVID-19 in adult patients through comparison of clinical markers and inflammatory indexes. A systematic search was conducted on the following databases: PubMed, WHO COVID-19 database, Ovid MEDLINE, and Web of Science between the dates of June 15, 2020, and June 30, 2020. Key search terms used included: "sex", "gender", "SARS-COV-2", "COVID" and "mortality". We accepted the following types of studies concerning adult COVID-19 patients: retrospective cohort, observational cohort, case series, and applied research. Further studies were extracted from reference searching. The risk of bias was determined using the National Institutes of Health Quality Assessment Tool for Observational Cohort, Cross-Sectional Studies, and Case Series. We identified a total of 16 studies published between January 2020 and June 2020 for analysis in this systematic review. Our study population consisted of 11 cohort studies, four case series, and one genetic study, including a total of 76,555 participants. Ten of the studies included in this review observed a higher risk of mortality among males compared to females, and eight of these studies found this risk to be statistically significant. Sex-disaggregated COVID-19 mortality data identifies male patients with comorbidities as being at an increased risk of mortality worldwide. Further investigation revealed differences in immune response regulated by sex hormones, angiotensin-converting enzyme 2 (ACE2) expression, and health behaviours as contributing factors to increased risk of mortality from COVID-19 among males. Nine out of the 16 studies included were conducted in China. In order to comprehensively assess sex-differences in the risk of mortality from COVID-19, more studies will need to be conducted worldwide. Sex-disaggregated COVID-19 data published in the medical literature is limited, however it has become evident that male sex is an important risk factor for mortality. Further exploration into the impact of sex on this pandemic is required in order to develop targeted therapies, as well as public health policies, and to prevent sex bias in treatment.
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Affiliation(s)
- Monica Kelada
- Infectious Diseases, Imperial College London, London, GBR
| | - Ailin Anto
- Infectious Diseases, Imperial College London, London, GBR
| | - Karishma Dave
- Infectious Diseases, Imperial College London, London, GBR
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Sayin I, Kadihasanoglu M. Evaluation of blood platelet count and function in patients with erectile dysfunction. Andrologia 2017; 49. [PMID: 28387063 DOI: 10.1111/and.12645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Irmak Sayin
- Internal Medicine, Ufuk University School of Medicine, Ankara, Turkey
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Yang K, Tao L, Mahara G, Yan Y, Cao K, Liu X, Chen S, Xu Q, Liu L, Wang C, Huang F, Zhang J, Yan A, Ping Z, Guo X. An association of platelet indices with blood pressure in Beijing adults: Applying quadratic inference function for a longitudinal study. Medicine (Baltimore) 2016; 95:e4964. [PMID: 27684843 PMCID: PMC5265936 DOI: 10.1097/md.0000000000004964] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
The quadratic inference function (QIF) method becomes more acceptable for correlated data because of its advantages over generalized estimating equations (GEE). This study aimed to evaluate the relationship between platelet indices and blood pressure using QIF method, which has not been studied extensively in real data settings.A population-based longitudinal study was conducted in Beijing from 2007 to 2012, and the median of follow-up was 6 years. A total of 6515 cases, who were aged between 20 and 65 years at baseline and underwent routine physical examinations every year from 3 Beijing hospitals were enrolled to explore the association between platelet indices and blood pressure by QIF method. The original continuous platelet indices were categorized into 4 levels (Q1-Q4) using the 3 quartiles of P25, P50, and P75 as a critical value. GEE was performed to make a comparison with QIF.After adjusting for age, usage of drugs, and other confounding factors, mean platelet volume was negatively associated with diastolic blood pressure (DBP) (Equation is included in full-text article.)in males and positively linked with systolic blood pressure (SBP) (Equation is included in full-text article.). Platelet distribution width was negatively associated with SBP (Equation is included in full-text article.). Blood platelet count was associated with DBP (Equation is included in full-text article.)in males.Adults in Beijing with prolonged exposure to extreme value of platelet indices have elevated risk for future hypertension and evidence suggesting using some platelet indices for early diagnosis of high blood pressure was provided.
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Affiliation(s)
- Kun Yang
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University
- Beijing Municipal Key Laboratory of Clinical Epidemiology
| | - Lixin Tao
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University
- Beijing Municipal Key Laboratory of Clinical Epidemiology
| | - Gehendra Mahara
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University
- Beijing Municipal Key Laboratory of Clinical Epidemiology
| | - Yan Yan
- Beijing Electric Power Hospital, Fengtai District
| | - Kai Cao
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University
- Beijing Municipal Key Laboratory of Clinical Epidemiology
| | - Xiangtong Liu
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University
- Beijing Municipal Key Laboratory of Clinical Epidemiology
| | - Sipeng Chen
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University
- Beijing Municipal Key Laboratory of Clinical Epidemiology
| | - Qin Xu
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University
- Beijing Municipal Key Laboratory of Clinical Epidemiology
| | - Long Liu
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University
- Beijing Municipal Key Laboratory of Clinical Epidemiology
| | - Chao Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University
- Beijing Municipal Key Laboratory of Clinical Epidemiology
| | - Fangfang Huang
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University
- Beijing Municipal Key Laboratory of Clinical Epidemiology
| | - Jie Zhang
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University
- Beijing Municipal Key Laboratory of Clinical Epidemiology
| | - Aoshuang Yan
- Beijing Municipal Science and Technology Commission
| | - Zhao Ping
- Beijing Xiaotangshan Hospital, Changping District, Beijing, China
- Correspondence: Ping Zhao, Research fellow, Bachelor degree, Beijing Xiaotangshan Hospital, No. 390, Hot Spring Avenue, Xiaotangshan Town, Changping District, Beijing 100069, China (e-mail: ); Prof. Dr. Xiuhua Guo, Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, No.10 Xitoutiao, You’anmen Wai, Fengtai District, Beijing 100069, China (e-mail: )
| | - Xiuhua Guo
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University
- Beijing Municipal Key Laboratory of Clinical Epidemiology
- Correspondence: Ping Zhao, Research fellow, Bachelor degree, Beijing Xiaotangshan Hospital, No. 390, Hot Spring Avenue, Xiaotangshan Town, Changping District, Beijing 100069, China (e-mail: ); Prof. Dr. Xiuhua Guo, Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, No.10 Xitoutiao, You’anmen Wai, Fengtai District, Beijing 100069, China (e-mail: )
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